Clinical Report: Infectious Risks of Extra-Peritoneal Pelvic Packing in Emergencies

Overview

Extra-Peritoneal Pelvic Packing (EPP) is an effective emergency procedure to control pelvic hemorrhage. This study evaluates whether performing EPP in the Emergency Room (ER) increases infection risk compared to the Operating Room (OR), finding no significant difference in infection rates between the two settings.

Background

Pelvic fractures with hemorrhagic shock are life-threatening, with exsanguinating hemorrhage as the leading cause of early death. EPP, introduced in the 1990s and refined over time, is a key technique to control pelvic bleeding, often performed in ER or OR settings. While EPP effectively controls venous and some arterial bleeding, local infection remains the main complication, with reported rates between 15–35%, especially if packing removal is delayed beyond 48 hours. This study investigates infection risks associated with EPP performed in different clinical environments.

Data Highlights

Key Findings

• EPP can be safely performed in the ER without increasing infection risk compared to the OR.
• Local infection remains the primary complication of pelvic packing, with rates between 15–35%.
• Infection risk increases if packing is removed after 48 hours; protocol mandates removal within 24–48 hours.
• Patients with open fractures or associated bladder/bowel injuries have higher infection rates post-EPP.
• Microbiological contamination combined with clinical signs (fever, leukocytosis, elevated CRP) defines pelvic infection diagnosis.
• Propensity Score Matching adjusted for injury severity and fracture pattern to compare ER and OR groups effectively.

Clinical Implications

Clinicians can consider performing EPP in the ER for hemodynamically unstable pelvic fracture patients without increased infectious risk, facilitating rapid hemorrhage control. Strict adherence to timely removal of packing within 48 hours is critical to minimize infection. Awareness of higher infection risk in patients with open fractures or visceral injuries should guide monitoring and management.

Conclusion

EPP is a life-saving procedure that can be safely executed in emergency settings without increasing infection risk, provided that packing removal protocols are followed. This supports broader use of EPP in critical trauma care environments.

References

1. Logothetopulos 1926 -- Introduction of pelvic packing
2. Pohlemann 1994 -- Modification of EPP technique
3. Burlew et al. -- Pelvic space infections post EPP
4. Italian Consensus Conference 2013 -- Role of EPP in unstable pelvic fractures